Understanding the Medicare Hospice Benefit

The Medicare Hospice Benefit is aimed at offering high-quality care during the final stages of life, without any cost to those on Medicare or their relatives. Since its introduction in 1983, it has been focused on providing patient-oriented care for those facing a terminal illness with an expected lifespan of six months or less, assuming the illness progresses as usual.

What Does the Medicare Hospice Benefit Cover? 

Under this benefit, patients receive comprehensive care connected to their terminal illness. This includes regular visits by a dedicated hospice care team comprising nurses, aides, social workers, chaplains, volunteers, and a bereavement coordinator, all led by the hospice's medical director. The team is there to offer physical, personal, spiritual, and emotional support, assist in organizing the patient's affairs, and provide grief counseling for the family. This support is available no matter where the patient lives, whether it's in a nursing home, an assisted living facility, or their own home.

Moreover, this benefit ensures the provision of all necessary medications, medical equipment, and supplies linked to the terminal diagnosis. Additionally, it provides up to five days of respite care in a certified facility to offer family caregivers a much-needed rest, with a minimal co-payment requirement for this service. It's important to discuss respite care options with your hospice care team ahead of time.

What Isn’t Covered by the Medicare Hospice Benefit? 

Opting for hospice care means deciding against curative treatments for the terminal condition, either because such treatments are ineffective or the patient prefers to focus on living as well as possible in the remaining time. Starting hospice care means Medicare will not cover treatments aimed at curing the terminal illness or related conditions. If there's a specific medication concern, your hospice team can often find a solution that continues to alleviate symptoms.

Hospice care is comprehensive, with the hospice team managing all care aspects upon admission. Treatments from providers outside the hospice team are not covered by Medicare, nor are room and board, except for short-term respite or inpatient care managed by the team. Also, outpatient services, hospital stays, or ambulance use are not covered unless arranged by your hospice team or for conditions not related to the terminal illness.

How Long Is Hospice Covered Under the Medicare Hospice Benefit? 

Hospice care under this benefit is designed for those expected to live six months or less if the illness follows its normal course. Care is structured in benefit periods, starting with two 90-day benefit periods followed by unlimited 60-day benefit periods. A benefit period begins the day hospice care starts and concludes at the end of the designated 90 or 60-day benefit period.

Patients can continue receiving care beyond a benefit period if the hospice medical director recertifies their terminal illness status. Should a patient's condition improve, they may be discharged but can re-enter hospice care if their condition worsens later.

Can a Patient Change Their Mind and Leave Hospice?

Patients have the freedom to halt hospice care at any time, whether due to health improvement, a desire to seek curative treatments again, or for any other reason. Upon deciding to stop hospice care, you'll receive a form indicating the end date of your care.

Get Top-Rated Home Hospice Care in Your Area Today

The Medicare hospice benefit ensures that those covered by Medicare have access to compassionate end-of-life care in their preferred setting. Anvoi is committed to supporting Medicare beneficiaries and all our patients in these critical moments. If you’re ready to start the process of seeing your loved one spending the rest of their time in capable hands in the comforts of their familiar settings, reach out to us today via phone or email. 

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Anvoi has been providing hospice care since 2013 with over 100 years of accumulated experience.

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